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What Parents of Every Teen Should Know About Meningitis

The most important thing parents of teens need to know about meningococcal disease is that it can be very serious.  And by serious, we mean debilitating and often deadly.

Even with prompt medical treatment, about 1 in 10 people with meningococcal disease will die from it. Of those who survive, about 1 to 2 will have permanent disabilities such as brain damage, hearing loss, loss of kidney function or limb amputations.

The best thing parents can do to protect their children from meningococcal disease is to get them vaccinated against all of the preventable forms of the disease.

 What causes meningitis and meningococcal disease?

Meningitis refers to a swelling of the protective membranes that cover the brain and spinal cord.   While meningitis is commonly caused by a bacterial or viral infection, it can also be caused by injuries, cancer, certain drugs, and other types of infections.

Meningococcal disease is specific to any illness caused by the bacterium Neisseria meningitidis (also referred to as meningococcus or meningococcal meningitis).  These types of infections can cause meningitis, but can also cause bloodstream infections (known as bacteremia or septicemia).

It’s possible to have meningitis without having meningococcal disease, and it’s possibly to have a type of meningococcal disease that isn’t necessarily meningitis.  The specific cause of illness is important to identify because the treatment differs depending on the cause.

  • Bacterial forms of meningitis can be extremely dangerous and fast-moving and have the greatest potential for being fatal. The long-term effects of bacterial meningitis can include multiple amputations, hearing loss and kidney damage. Many, but not all, forms of bacterial meningitis can be prevented by vaccination.
  • Viral meningitis has similar symptoms to bacterial meningitis, but for the most part is neither as deadly nor as debilitating. There is no specific treatment available for viral meningitis, but most patients fully recover over time.
Meningococcal Disease Facts

Who is at risk?

While anyone can contract meningococcal disease, adolescents and young adults are among the population who have a higher risk for the disease due to their lifestyle factors.  For instance, the risk of meningococcal is higher for those who are living in crowded settings such as college dormitories, boarding schools, sleep-away camps or military barracks. Other factors that can raise the risk of infection include:

  • Attendance at a new school with students from geographically diverse areas
  • Irregular sleeping patterns
  • Active or passive smoking
  • Social situations where there is crowding
  • Moving to a new residence

How is it spread?

About one in ten people carry meningococcal bacteria in their nose or throat without showing any signs or symptoms of the disease. These people can unknowingly transmit the bacteria to others through the exchange of respiratory secretions during close or lengthy contact with someone’s saliva, such as through kissing or coughing, especially if they are living in close quarters.  Although meningococcal bacteria are very dangerous, they cannot live outside the body for very long.  This means that while contagious, the infection is not as easily spread as a cold virus.

How can it be prevented?

Currently, vaccination is the best defense against meningococcal disease. There are five major serogroups of meningococcal disease (A, C, W, Y and B). The three most commonly seen in the United States are B, C and Y, with one-third of all cases in the U.S. being of serogroup B.

In order to be protected against all the preventable strains of meningococcal disease, teens need to receive multiple doses of two different kinds of meningococcal vaccines.

Meningococcal Conjugate Vaccine (MenACWY):  Routine vaccination with the conjugate is recommended at age 11-12 to protect against serogroups A, C, W and Y. Adolescents should also get a vaccine booster dose at age 16.

Meningococcal Serogroup B Vaccine (MenB): This vaccine is recommended for people 10 years or older who are at increased risk for serogroup B meningococcal infections including:

  • People at risk because of a serogroup B meningococcal disease outbreak.
  • Anyone whose spleen is damaged or has been removed.
  • Anyone with an immune system condition known as “persistent complement component deficiency”.
  • Anyone taking a drug called eculizumab (Soliris).
  • Microbiologists who routinely work with N. meningitidis isolates.

The CDC also recommends permissive use of the MenB vaccine for adolescents and young adults age 16-23, with a preferred age of 16 to 18. A permissive recommendation means that it is at a doctor’s discretion whether they will recommend the vaccine to those who don’t fall into the categories listed above.  If a provider doesn’t feel the patient is at risk, they may fail to mention the availability of the vaccine.

This does not mean that a parent can’t request or receive the vaccine for their child.    

It’s critical that parents understand that serogroup B meningococcal disease is not only the most common cause of meningococcal disease in adolescents and young adults, but it has also cause several outbreaks on college campuses over the past few years.

Meningococcal Disease on U.S. College Campuses, 2013-2017

Graphic compiled by the National Meningitis Association

The vaccine has been deemed safe by the FDA, and has been recommended by the CDC, so parents should feel comfortable getting the vaccine for their child, especially if they feel they are at risk of exposure.  If a child is attending college, parents may want to take the precaution of getting them vaccinated before they arrive on campus.  In the case of an outbreak, the vaccine will be recommended.  However, if your child is exposed before the outbreak is identified than it may be too late to benefit from the vaccine.

What are the symptoms and can it be treated?

The symptoms of meningococcal disease are the same for all of the serogroups.  Unfortunately, it is not easy for healthcare professionals to identify and diagnose the infection in its early stages and it’s often mistaken for the flu or other viral infections.  Symptoms tend to develop over several hours or over one or two days, and may include:

  • Sudden high fever
  • Severe headache
  • Stiff neck
  • Vomiting or nausea with headache
  • Confusion or difficulty concentrating
  • Seizures
  • Sleepiness or difficulty waking up
  • Sensitivity to light
  • Lack of interest in drinking and eating
  • Skin rash

Meningococcal disease can be treated with antibiotics, but treatment must begin early to be effective. Even if treatment is started as soon as possible, it might not prevent death or serious long-term complications such as hearing loss, brain damage, kidney disease or limb amputations.

Today we are grateful for moms like the ones featured in this video who are helping to raise awareness about the two available meningococcal vaccines for adolescents and young adults. May their stories help parents to make educated decisions about disease prevention.

Visit the following websites for more information on the dangers of meningitis and how it can be prevented.

Vaccinate Your Family – PreTeens & Teens Meningococcal Disease

National Meningitis Association

The Kimberly Coffey Foundation

The Emily Stillman Foundation

Meningitis Angels

October Updates from Advisory Committee on Immunization Practices

October 26, 2016 3 comments

10693.jpgLast week, the Advisory Committee on Immunization Practices (ACIP) held it’s third and final meeting of 2016.  The agenda included presentations pertaining to hepatitis B, pertussis, HPV, meningococcal, herpes zoster, pneumococcal and RSV vaccines, and surveillance updates on Zika and influenza viruses.

During the two-day meeting, the committee took nine votes on newly proposed vaccine recommendations that addressed vaccination timing, number of doses needed, and dosing intervals for hepatitis B, pertussis, HPV and meningococcal vaccines.  They also approved the child, adolescent and adult immunization schedules.

This post provides a recap of each agenda item in the order they occurred. 

Hepatitis B Vaccine

The recommended first dose of the three-series hepatitis B vaccine is often referred to as “birth dose” and is typically administered to infants in the hospital after birth.  At this meeting, the Hepatitis B Work Group asked that the Committee consider removal of the permissive language that appears at the end of the recommendation which allows for a delay of the birth dose until after hospital discharge.

When hepatitis B vaccine is administered within 24 hours of birth it can help prevent transmission of the hepatitis B virus from an infected mother to her child.  The intent of the birth dose is to provide an additional safety net to prevent transmission from HepB positive mothers that are not properly identified due to errors in maternal testing or reporting. In these instances, when the mother is not properly identified as HepB positive before birth, the HepB vaccine alone is 75% effective in preventing prenatal transmission, and 94% effective when used in conjunction with Hepatitis B immune globulin.

Since delaying hepatitis B vaccination can interfere with the prevention of Hepatitis B – especially in a child unknowingly born to a HepB positive mother – the HepB Work Group proposed that the reference to delaying vaccination be removed from the recommendation.  It had originally been added in 2005, but the data suggests that administering the birth dose in the hospital leads to timely completion of the series. The current birth dose coverage was stated to be 72.4% of children, which remains below the Healthy People 2020 goal of 84%.

The Committee voted to remove the permissive language as well as include new language to clarify that the first dose of vaccine should be administered within 24 hours of birth, which is more explicit than “before hospital discharge”.

The anticipated changes to the previous recommendation are indicated below, however the exact wording may differ once published by the CDC:

“For all medically stable infants weighing 2,000 grams or more at birth and born to HBsAg-negative mothers, the first dose of vaccine should be administered before hospital discharge within 24 hours of birth.  Only single antigen HepB vaccine should be used for the birth dose. On a case-by-case basis and only in rare circumstances, the first dose may be delayed until after hospital discharge for an infant who weighs 2,000 grams or more and whose mother is HBsAG-negative.

*It should be noted that for those infants with birth weight of less than 2,000 grams, the birth dose is not counted as part of the vaccine series.

There was some discussion concerning the removal of the option to delay vaccination and it was emphasized that having a clear recommendation from the ACIP is not a vaccine mandate.  Rather, practitioners, public health professionals and parents rely on the ACIP recommendations as expert guidance and best practice. The Hepatitis B “birth dose” has been a successful strategy to help eliminate hepatitis B virus transmission in the U.S., and the ACIP’s revised recommendations only emphasize the importance of vaccinating within the 24 hours timeframe that will help prevent further transmission.

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Other key updates to the hepatitis B vaccine recommendations included:

  • Providing examples of chronic liver disease, including recommending HepB vaccine for persons with HCV infection.
  • Post vaccination serologic testing for infants who’s mother’s HBsAg status remains  unknown indefinitely.
  • Testing HBsAg-positive pregnant women for HBV DNA.

For more information as to why babies need a Hepatitis B vaccine at birth, read these Shot of Prevention blog posts here

Pertussis Vaccine

The Committee reviewed the history of Tdap vaccination in pregnant women and reviewed studies that found that maternal Tdap vaccination to both safe and effective at preventing infant pertussis. Read more…

I Want Parents to Know About the Additional Meningococcal Vaccine That Could Have Saved My Daughter

August 25, 2016 1 comment
This guest post has been written by Patti Wukovits, a Registered Nurse and Executive Director of The Kimberly Coffey Foundation, as part of National Immunization Awareness Month’s week-long focus on the importance of preteen and teen vaccination.

PattiAndKimberlyCoffey

As a mother and a nurse, I was vigilant in having both of my children up-to-date on all recommended vaccinations, including meningococcal vaccination. I was under the common misconception, as many parents are, that the meningococcal vaccine that my daughter received would fully protect her from meningococcal disease, when in fact, it didn’t protect her against meningitis B. The meningococcal vaccine (MCV4) only protects against four of the five common groups (ACWY), leaving adolescents and young adults vulnerable to meningitis B. Meningitis B is a type of bacterial meningitis, also known as meningococcal disease, which is a potentially fatal bacterial infection that can kill a healthy person within 24 hours.KimberlyCoffey

When my daughter Kimberly Coffey died in 2012 from bacterial meningitis, a vaccine was not available to protect her. But since 2014, meningitis B vaccination has been available in the United States. Kimberly was a perfectly healthy 17-year-old high school senior, and I believe she would be alive today if meningitis B vaccination had been available to her.

I established The Kimberly Coffey Foundation in Kimberly’s honor to educate other parents and health care providers about meningitis B, also known as MenB.

It’s critical that parents know that MenB vaccination is now available, and that without requesting MenB vaccination in addition to the common meningococcal vaccine (MCV4), their child will not be fully protected against meningococcal disease and MenB.

The Kimberly Coffey Foundation has partnered with Pfizer on the National Meningococcal Disease Awareness Survey to gain a better understanding of parents’ knowledge of meningococcal disease and its available vaccines.  This 2016 survey revealed that nearly 4 out of 5 parents didn’t know their child wasn’t fully immunized against the five common groups of meningococcal disease unless they had two meningococcal vaccines (MCV4 and MenB).

The bottom line is this – without adding MenB vaccination, we are going to lose more lives. There will continue to be more college outbreaks, especially since MenB has been responsible for several recent college outbreaks in the United States.  According to data released by the CDC, MenB currently accounts for approximately 50% of meningococcal disease in the United States among persons aged 17-22 years old. MenB vaccination is available for individuals ages 10-25, and public health insurance and most private insurance plans provide coverage.  However, your child’s provider may not mention it.

I want parents to have the knowledge to request MenB vaccination, in addition to the meningococcal vaccine, so that their children can potentially be fully protected against this devastating disease.

As a mother who lives every day with the heartache of not seeing my beautiful daughter live the full life she deserved, I know only too well how important MenB vaccination is. My daughter Kimberly’s life was one too many lost to this terrible disease.

KimberlyCoffeyFoundationLogoI will be Kimberly’s voice as I continue to promote awareness of meningococcal disease, which includes MenB. I don’t ever want another parent to experience what I have. And more important, I don’t want another person to experience what Kimberly did when she battled for her life.

Kimberly contracted MenB two years too early—two years before the MenB vaccine was made available.  She didn’t have the protection of the MenB vaccination, but your children can. Please protect your children – because YOU can.

 

For more information about meningitis B and the MenB vaccine, please visit the Kimberly Coffey Foundation at www.kimberlycoffeyfoundation.org.

 


Every Child By Two (host of the Shot of Prevention blog) welcomes guest blog posts on a variety of vaccine related issues.  The views and opinions expressed in these guest posts do not necessarily represent the views of the Every Child By Two organization.

Highlights from June Meeting of Advisory Committee on Immunization Practices

June 30, 2016 1 comment

Original Title: BLDG21_0023.jpg

Three times a year a specialized group of medical and public health experts meet to review scientific data related to vaccine safety and effectiveness. This group, known as the Advisory Committee on Immunization Practices (ACIP), has an enormous responsibility.  They establish, update and continually evaluate all the vaccine recommendations that are made in the United States for infants, adolescents and adults. Health insurance coverage of vaccines is based on these recommendations and the ACIP guidelines are considered the gold standard among healthcare providers.

Last week, in their second meeting of 2016, the ACIP discussed cholera, meningococcal, hepatitis, influenza, RSV and HPV vaccines, as well as the safety of maternal Tdap immunization and the laboratory containment of Poliovirus Type 2.  

Below you will find a recap of the highlights of the June 2016 ACIP meeting to help keep you informed of the latest ACIP recommendations and considerations. 

Influenza Vaccine

The most significant and somewhat surprising decision that occurred during last week’s ACIP meeting was that the Committee voted in favor of an interim recommendation that live attenuated influenza vaccine (LAIV), also known as the nasal spray flu vaccine, should not be used during the 2016-2017 flu season. 

The vote followed an extensive review of data investigating the effectiveness of the nasal spray flu vaccine over the past three flu seasons.  The data showed vaccine effectiveness for nasal spray vaccine among children 2 through 17 years during 2015-2016 was only 3% effective (with a 95% Confidence Interval of -49-37%). In comparison, flu shots had a vaccine effectiveness estimate of 63% against any flu virus among children 2 through 17 years (with a 95% Confidence Interval of 52-72%). This estimate clearly indicates that while no protective benefit could be measured from the nasal spray vaccine in this past season, flu shots provided measurable protection in comparison.

The disappointing vaccine effectiveness data for the nasal spray vaccine during the 2015-2016 season follows two previous seasons (2013-2014 and 2014-2015) that also showed poor and/or lower than expected vaccine effectiveness for LAIV.  (More information about past LAIV VE data is available here.)

child_h1n1_flu_shotWhile it’s disheartening to see data suggesting that the nasal spray flu vaccine did not work as well as expected, the data did suggest that flu shots did perform well and offered substantial protection against influenza this past season. Some patients prefer the nasal spray flu vaccine due to an aversion to needles and may be disappointed in this vote. However, the action taken by the ACIP  emphasizes the important role they fill in continually measuring and evaluating vaccine effectiveness.  Only after a thorough review of the latest scientific data and discussion among the Committee do they decide to alter vaccine recommendations to ensure that they are in the best interest of the public’s health.

ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) for everyone 6 months and older and the CDC expects that there should be no shortage of injectable vaccines.  However, it should be noted that with the ACIP vote the nasal spray flu vaccine should not be used during the 2016-2017 season and therefore should not be offered by providers or clinics and will not be covered under the Vaccines For Children (VFC) program.

Cholera Vaccine

A vote was taken to recommend the vaccine for people traveling to high risk areas. 

For more information about cholera visit the CDC travel page here and for up-to-date travel alerts that address various destinations and diseases, we recommend visiting Passport Health’s travel alerts here.

Meningococcal Vaccine

The first part of the discussion of meningococcal vaccines was a consideration of the data on the serogroup B vaccine Trumenba.  This particular vaccine is currently administered on a three dose schedule, however Pfizer’s Dr. Laura York indicated during her presentation that the FDA has approved both a 2 and 3 dose schedule based on the data showing both schedules to be considered safe and effective.  While immunity data suggests that the 3 dose schedule may confer slightly greater immunity over longer periods of time, the 2 dose schedule would be considered optimal in the case of an outbreak or when it is important to confer rapid immunity.   The committee will be reviewing more data on the duration of immunity and the safety of a 2 dose versus 3 dose schedule at the October meeting, before a formal recommendation is made for persons at increased risk, for use during outbreaks or for all healthy adolescents. Read more…

Why My Kid Won’t Be Getting These New Vaccines Anytime Soon

September 11, 2015 7 comments

There’s a part of me that understands why some people are hesitant to get newly approved and recommended vaccines.

“I don’t want my child to be a pharmaceutical guinea pig.”

“The vaccine hasn’t been around long enough.  How can we really know the long-term side effects?”    

“I didn’t have half the vaccines that kids today get and I survived.  Why do we bother to give so many vaccines for diseases that aren’t even all that serious?”

These are the kind of comments I’ve heard in school, at the doctor’s office, on the playground with other parents, or posted as comments on social media. While I understand that people may be hesitant, and sometimes even fearful, of something new, I tend to address my concerns by learning more about whatever it is I’m afraid of.

Since I began contributing to this blog six years ago, I’ve tried to address some of the most popular immunization concerns I’ve heard from other parents.  In sharing what I’ve learned, It is my sincere hope that others will be better able to make informed immunization decisions based on the sound scientific evidence that I include in my posts.

However, the approval of two new vaccines (HPV9 and MenB) have actually caused me much concern and distress lately.

It’s not that I’m worried about the dangers of these new vaccines.  Quite the contrary.  

I’ve sat through enough presentations at immunization conferences and committee meetings to appreciate the extensive amount of data that is collected and analyzed by hundreds of scientists and doctors as a vaccine makes it’s way through the various phases of clinical trials.

img3I’ve become familiar with the elaborate process that leads to FDA approval, and I’ve witnessed discussions by the Advisory Committee on Immunization Practices (ACIP) when they’ve considered modifications or additions to the recommended vaccine schedule.  By the time a new vaccine is ever recommended for my child, the vaccine has already been administered to thousands of people in clinical trials and the vaccine’s efficacy and potential adverse effects have already been well documented.  In fact, many vaccines, are already being used in foreign countries for years prior to being approved here in the U.S.  This provides a considerable amount of safety and efficacy data for us to analyze prior to U.S. licensure and recommendations.

With all the available data that is scrutinized by so many experts, I’m not concerned at all about the vaccine’s safety.  What I am concerned about is how long it takes for the public to finally have access to these new vaccines after FDA approval and ACIP recommendation.

In the case of these two new vaccines (HPV9 and MenB) my personal experience has been far from ideal.  It’s been at least three months since the new ACIP recommendations and yet I’m still unable to locate a single dose of either vaccine within a 50 mile radius of my home.  To make matters worse, I’m hearing reports from parents who are getting inaccurate information about the availability of these vaccines. Read more…